CT对肝硬化患者食管静脉曲张诊断和严重程度评估的应用价值  

The utility of CT for the diagnosis and severity assessment of esophageal varices in patients with cirrhosis

作　　者：陈诚[1] 须佳平 苏文婷[1] 潘自来[1] CHEN Cheng;XU Jia-ping;SU Wen-ting(Radiology Department,Ruijin Hospital,Shanghai Jiaotong University School of Medicine(Shanghai,201800)China)

机构地区：[1]上海交通大学医学院附属瑞金医院北部院区放射科,上海201800

出　　处：《中西医结合肝病杂志》2022年第8期726-730,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨CT对肝硬化患者食管静脉曲张(EV)诊断和严重程度评估的应用价值。方法:回顾性选择本院收治的慢性乙型病毒性肝炎肝硬化患者138例,以胃镜诊断为标准,评价CT对EV的诊断价值,分析EV的CT分级和胃镜分级的一致性。通过CT测量食管静脉直径、门静脉直径、脾静脉直径、肝脏体积、脾脏体积和肝脏体积/脾脏体积,分析上述指标对EV的诊断价值及与EV分级的相关性。结果:CT对EV的诊断灵敏度为96.4%,特异度为82.1%,阳性预测值为95.5%,阴性预测值为85.2%,准确度为93.5%。EV的CT分级和胃镜分级具有较强的一致性(Kappa值=0.638,P<0.001)。不同EV分级患者的CT定量指标差异具有统计学意义(P<0.05),随着EV分级增加,食管静脉直径、门静脉直径、脾静脉直径和脾脏体积有逐渐升高的趋势,而肝脏体积和肝脏体积/脾脏体积有逐渐降低的趋势。食管静脉直径、门静脉直径、脾静脉直径、肝脏体积、脾脏体积和肝脏体积/脾脏体积均对EV有较好的诊断价值(曲线下面积分别为0.915、0.771、0.884、0.748、0.870、0.866,均P<0.001)。当上述指标各取值3.015 mm、14.010 mm、8.600 mm、3103.955 cm^(3)、905.660 cm^(3)、2.820时,敏感度分别为100.0%、92.9%、96.4%、64.3%、89.3%、92.9%,特异度分别为73.6%、53.6%、74.5%、80.9%、79.1%、67.3%。EV分级与食管静脉直径、门静脉直径、脾静脉直径、脾脏体积呈正相关(r分别为0.794,0.566,0.744,0.719,均P<0.001),与肝脏体积、肝脏体积/脾脏体积呈负相关(r分别为-0.528,-0.770,均P<0.001)。结论:CT成像可用于肝硬化患者EV诊断和严重程度评估,可作为胃镜的替代检查手段。Objective:To investigate the application value of CT in the diagnosis and severity evaluation of esophageal varices in patients with liver cirrhosis.Methods:A total of 138 patients with chronic hepatitis B cirrhosis in our hospital were selected retrospectively.The diagnostic value of CT in EV was evaluated according to gastroscopy diagnosis,and the consistency of CT grading and gastroscopy grading of EV were analyzed.The diagnostic value of CT in EV was evaluated and the consistency of CT grading and gastroscopy grading were analyzed.The diagnostic value of CT in EV was evaluated and the consistency of CT grading and gastroscopy grading were analyzed.The esophageal vein diameter,portal vein diameter,splenic vein diameter,liver volume,spleen volume and liver volume/spleen volume were measured by CT,and the diagnostic value of the above indicators for EV and their correlation with EV grading were analyzed.Results:CT diagnostic sensitivity to EV was 96.4%,specificity of 82.1%,positive prediction of 95.5%,negative prediction of 85.2%,and accuracy of 93.5%.The CT and gastroscopy levels for EV have strong consistency(Kappa=0.638,P=0.000).Differences in CT quantitative metrics between patients with different EV grades were statistically significant(P<0.05),with a trend of increasing esophageal vein diameter,portal vein diameter,splenic vein diameter,and spleen volume as EV grade increased,whereas liver volume and liver volume/spleen volume showed a trend of decreasing gradually.Esophageal vein diameter,portal vein diameter,splenic vein diameter,liver volume,spleen volume,and liver volume/spleen volume all had good diagnostic value for EV(AUC:0.915,0.771,0.884,0.748,0.870,0.866,all P<0.001).When each of the above indexes took the values of 3.015 mm,14.010 mm,8.600 mm,3103.955 cm,3,905.660 cm,3,2.820.Sensitivity was 100.0%,92.9%,96.4%,64.3%,89.3%,92.9%respectively,and specificity was 73.6%,53.6%,74.5%,80.9%,79.1%,67.3%respectively.EV grades showed a positive correlation with esophageal vein diameter,portal vein diameter,

关 键 词：电子计算机断层扫描 肝硬化 食管静脉曲张 诊断 严重程度 

分 类 号：R445.3[医药卫生—影像医学与核医学]